<h1 id="[h1]"><l10n>Insert Note</l10n></h1>
<div style="margin: 10px 10px 0px 10px;">
  <label><l10n>Insert</l10n></label>
  <select id="[noteMenu]" name="[noteMenu]" style="margin-bottom: 6px; width: 200px;">
    <option selected value="new" id="[newNoteOption]">New footnote</option>
  </select>
  <textarea id="[noteContent]" name="[noteContent]" style="width: 375px;" rows="6"></textarea>
</div>
<div class="buttons">
  <input type="button" id="[ok]" value="_(Insert)" />
  <input type="button" id="[cancel]" value="_(Cancel)" />
</div>
